Kraisid Tontisirin

Coordinated Strategies for Controlling Micronutrient Malnutrition: A Technical Workshop

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

Community-based programmes: success factors for public nutrition derived from the experience of Thailand.

Thailand has faced the major nutritional problems of protein–energy malnutrition and micronutrient deficiencies, notably iron, iodine, and vitamin A deficiencies. for decades, the problem was addressed through the national health planning system. Its alleviation was embedded in a service-driven approach, which not only consumed a disproportionate share of the government budget, but also restricted participation by the people and depended heavily on centralized planning. This approach failed, resulting in a paradigm shift to community-driven programmes, which were seen as investments for the health of the Thai population. Nutrition was framed as part of the National Economic and Social Development Plan. A comprehensive situation analysis was undertaken and the results were used for community mobilizing, organizing, and financing, using basic minimum needs indicators to guide the process. Critical to the success of the community-based approach was the village-level volunteer system, which featured manageable ratios of mobilizers, facilitators, and households, interacting to define the needs of the communities and propose solutions.

Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy

Background: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. Aim: The aim of the study is to propose international compositional recommendations for FUF-YC. Methods: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. Results and Conclusions: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cows milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.

Nutrition actions in Thailand -- a country report.

Abstract Many strides have been made in nutrition and development by several developing nations. In particular, Thailand’s experiences in alleviating malnutrition (undernutrition) and improving overall quality of life have shown encouraging results. Almost 2 decades ago, with the development of the National Poverty Alleviation Plan (PAP), emphasizing the improvement of poverty stricken areas, the country was able to steer ahead in alleviating undernutrition A holistic approach integrating nutrition, primary health care, food production and other basic social services into developmental plans was undertaken. This evolved from a careful planning process at the macro and micro levels targeting integrated developmental actions towards the rural poor. Synthesis of national level policies with community based programs helped to optimize the potential of human, and organizational resources, which led to effective control of malnutrition.

Fructans in the first 1000 days of life and beyond, and for pregnancy.

Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic term that comprises β-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days of a childs life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of malnourished infants and children, especially those with infections in the developing world, are considered, as well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy to support health or prevent the development of certain diseases from conception to adulthood where inulin prebiotics may play a role.

Waist circumference and body fat distribution indexes as screening tools for the overweight and obesity in Thai preschool children

SUMMARY BACKGROUND Evidence shows that waist circumference (WC) is one reliable index to predict abdominal obesity in children. This study aims to examine the relationship of WC to other anthropometric indexes and to determine the ability of WC as obesity screening tool. SUBJECTS 811, 5-6 years old children in Saraburi province, central region of Thailand. METHODS Anthropometric measurements were performed in children; 406 boys and 405 girls. WC measurement was performed at the umbilicus level. Subcutaneous skinfold was measured on subscapular, suprailiac and abdominal regions. Total body fat was measured with bioelectrical impedance analyzer. Receiver operating characteristic (ROC) analysis was employed to determine WC cut-offs for predicting obesity in children. RESULTS WC highly correlated with weight-for-height Z-score (WHZ) (r = 0.92-0.94, p = 0.01), body mass index (BMI) (r = 0.95-0.96, p = 0.01), trunk skinfold (r = 0.92-0.93, p = 0.01) and total body fat (r = 0.94-0.95, p = 0.01) for both genders. Based on Thai national reference, the optimal WC cut-offs for predicting obesity were 59.6 cm for boys and 60.5 cm for girls. When IOTF-BMI was employed as reference, WC thresholds were 64.4 cm for boys and 63.1 cm for girls. The latter WC cut-offs provided the slightly underestimated obesity prevalence compared with national reference. CONCLUSION The strongly positive correlation between WC and weight-height based index and between WC and body fat in Thai preschool children suggests that WC should be the additional index for obesity screening in young children. Further study needs to explore the association between the increased WC and other adverse health outcomes.

Nutrient Recommendations for Growing-up Milk: A Report of an Expert Panel

Utilization of expert recommendations in the development of food and beverage nutritional profiles represents an opportunity to merge science and food manufacturing to deliver nutritionally optimized products into the marketplace. This report details expert panel guidelines for the design of a nutritional product for children one to six years of age. This interaction demonstrates the essential synergy between academia and food manufacturers in translating nutrient recommendations to food for their delivery to a population. Important factors for such translation are the identification of applicable nutrient recommendations and selection of an appropriate delivery matrix. This report demonstrates the translation of expert nutritional recommendations to a milk-based product for children—one to six years of age.

The Changing Climate of Health and Nutrition in Thailand: A Report from the Institute of Nutrition at Mahidol University

The Institute of Nutrition at Mahidol University (INMU) was established in 1977 as a national planning and implementation body for the Thai government. It has become an internationally recognized leader in the field of nutrition and its allied areas of population, health, agriculture, and rural development. The health and nutritional status of the Thai people has improved dramatically over the past 20 years as a direct result of effective programme planning and implementation in health, nutrition, and alleviation of poverty. Rapid socio-economic development, which generated a 14-fold increase in national income and an 8-fold increase in per capita income, also helped to make programmes sustainable. Household income steadily increased in real terms, and there is no doubt that the nation’s economic growth “trickled down” some benefits to the poor. National budget allocations for health care have remained quite stable, with a rate of increase parallel to that of the country’s economic performance. In times of economic hardship, the Ministry of Public Health has not been the prime target for budgetary cuts. Even while in the grips of the economic downturn that is affecting many Asian nations today, the Thai government’s budgetary adjustment efforts raised the proportion of the Ministry of Public Health budget from 7.1% to 7.5% of the total government budget in 1998. The budget for welfare health services increased 9.4%. Because of such political and economic commitments, virtually all health and social indicators are favourable in comparison to those in other developing nations. Some—–such as life expectancy, prevalence of contraceptive use, total fertility rate, and infant and child mortality rates—–are at or are quickly approaching those of industrialized nations. Thailand has also experienced The changing climate of health and nutrition in Thailand: A report from the Institute of Nutrition at Mahidol University